Silvia García-Garzón

Hospital Universitario Severo Ochoa, Madrid, Madrid, Spain

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Publications (10)

  • [Show abstract] [Hide abstract] ABSTRACT: Inflammatory bowel disease is associated with a high risk of deficient adherence to therapy. Our study was designed to analyze the adherence to treatment in a specialized inflammatory bowel disease clinic, and to study which factors could influence it. 107 consecutive patients (64% Crohn's disease, 36% ulcerative colitis) filled up an anonymous survey with data on demography, disease, therapy and a self-applied adherence declaration. A 69% (95%CI: 60-77%) showed some type of non-adherence. A 66% (95 CI%: 57-75%) acknowledged some involuntary non-adherence: either forgetting to take their dose (63%) or being careless about having taken it (27%). A 16% (95 CI%: 9-22%) showed some voluntary non-adherence: interrupting the therapy when feeling better (13%) or when feeling worse (6%). A 25% forgot at least a dose a week in the last 12 months. Multivariate analysis identified as risk factors for a lower adherence the dosing in three or more takes a day (OR 3; 95%CI: 1.1-8.4; p=0.03) and feeling little informed about their disease (OR 4.9; 95%CI: 1.1-23.8; p=0.04). Immunomodulator therapy predicted better adherence (OR 0.29; 95%CI: 0.11-0.74; p=0.01). Adherence to therapy in inflammatory bowel disease patients is not satisfactory, and worse in patients treated with mesalazine. Optimizing the information on the disease and giving the medication in one or two daily doses could enhance therapeutic adherence.
    Article · Oct 2010 · Journal of Crohn s and Colitis
  • Article · May 2010 · Gastroenterology
  • Iván Guerra · Luis-Ramón Rábago · Fernando Bermejo · [...] · Silvia García-Garzón
    [Show abstract] [Hide abstract] ABSTRACT: The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCP. This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications.
    Article · Nov 2009 · World Journal of Gastroenterology
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    [Show abstract] [Hide abstract] ABSTRACT: Azathioprine (AZA) liver toxicity arises in approximately 3% of inflammatory bowel disease patients and may result in treatment discontinuation. To describe the tolerance to mercaptopurine (MP) in patients with previous AZA-related liver injury. Retrospective description of 31 patients (14 Crohn's, 17 ulcerative colitis), in which AZA therapy was interrupted because of liver injury, with MP started as alternative therapy. Mean AZA dose was 2.2 +/- 0.4 mg x kg/day. Median (interquartile range) of AZA exposure when liver injury was detected was 2 months (1-5.2). The type of AZA-related injury was cytolitic in 32%, cholestatic in 39% and mixed in 29%. After a median of 2.5 months (0.7-5.2), the therapy was switched to MP at a mean dose of 1.3 +/- 0.2 mg x kg/day. Median of follow-up of MP therapy was 32 months (8-54). In 87.1% of patients (95%CI: 70-96%), MP was tolerated without further liver injury; of these, 77.4% tolerated full MP doses and 9.7% tolerated lower doses. In a further cohort of 12.9% of patients, (95%CI: 3-29%), liver injury reappeared (two cholestasis, two mixed), 1-3 months after the onset of MP exposure. The administration of MP is a good alternative in patients with AZA-related liver injury, before thiopurines are definitely discarded.
    Full-text Article · Sep 2009 · Alimentary Pharmacology & Therapeutics
  • [Show abstract] [Hide abstract] ABSTRACT: Patients with multiple myeloma (MM) do not have a higher incidence of acute pancreatitis or pancreatitis of other etiologies than the general population. However, these patients may develop acute pancreatitis, or hyperamylasemia or isolated hyperlipasemia, due to etiologies that are highly infrequent in the absence of hematological disease. Liver involvement is found in 30-50% of patients with MM and mainly manifests as diffuse sinusoidal infiltration and less frequently in the form of nodules. We report the case of a patient who underwent bone marrow transplantation due to MM who showed clinical and laboratory findings compatible with acute pancreatitis of unknown origin, during which the presence of multiple space-occupying hepatic lesions was identified. Based on the results of biopsy, a diagnosis of extramedullary recurrence of MM was established.
    Article · Jul 2009 · Gastroenterología y Hepatología
  • [Show abstract] [Hide abstract] ABSTRACT: Patients with multiple myeloma (MM) do not have a higher incidence of acute pancreatitis or pancreatitis of other etiologies than the general population. However, these patients may develop acute pancreatitis, or hyperamylasemia or isolated hyperlipasemia, due to etiologies that are highly infrequent in the absence of hematological disease. Liver involvement is found in 30–50% of patients with MM and mainly manifests as diffuse sinusoidal infiltration and less frequently in the form of nodules. We report the case of a patient who underwent bone marrow transplantation due to MM who showed clinical and laboratory findings compatible with acute pancreatitis of unknown origin, during which the presence of multiple space-occupying hepatic lesions was identified. Based on the results of biopsy, a diagnosis of extramedullary recurrence of MM was established.
    Article · Jun 2009 · Gastroenterology
  • Article · May 2009 · Gastroenterology
  • Article · May 2009 · Gastroenterology
  • [Show abstract] [Hide abstract] ABSTRACT: Objetivos La enfermedad inflamatoria intestinal (EII) constituye una entidad clínica en la que existe un riesgo elevado de baja adhesión al tratamiento. Nuestros objetivos fueron conocer el grado de adhesión al tratamiento en una consulta monográfica para pacientes con EII, y estudiar qué factores influyen la misma. Métodos Se incluyeron 107 pacientes consecutivos durante 3 meses. Previo consentimiento verbal, los pacientes rellenaron en otra sala una encuesta anónima con datos demográficos (edad, sexo, nivel de estudios, situación laboral, situación personal), datos referidos a la enfermedad (tipo de EII, año del diagnóstico, numero de ingresos hospitalarios y de intervenciones quirúrgicas por su EII), datos referidos al tratamiento (medicación, dosis e intervalo de administración), declaración autoaplicada de adhesión (Sewitch MJ et al. Am J Gastroenterol 2003) y automedicación. El médico recogió en hoja aparte tratamiento prescrito e índice de actividad (Harvey-Bradshaw/Truelove). Resultados Edad media 41,3±11 años, 60% mujeres, años de evolución con EII 7,9±7. Padecían enfermedad de Crohn 64% (71% inactiva), colitis ulcerosa 36% (70% inactiva). El 66% tomaba aminosalicilatos, 51% inmunosupresores, 8% esteroides. El 66% de enfermos había precisado por su EII algún ingreso hospitalario y el 17% alguna cirugía. Globalmente el 69% (IC95%: 60–77%) mostraba algún tipo de no-adhesión al tratamiento. El 66% (IC95%: 57–75%) reconocía algún grado de no-adhesión involuntaria: olvidaron alguna vez tomar la medicación (63%) y/o se descuidaron en cuanto a si debían tomarla (27%). El 16% (IC95%: 9–22%) reconocía algún grado de no-adhesión voluntaria: la habían dejado alguna vez por sentirse mejor (13%) y/o peor (6%) al tomarla. El 25% (IC95%: 17–33%) olvidaban al menos una toma a la semana (media 1,6 tomas olvidadas/semana, causa más frecuente: estar fuera de casa), más frecuentemente con mesalazina (30%) que con azatioprina (17%) (p=n.s.). En el analisis multivariante, los factores de riesgo de una peor adhesión fueron la dosificación de la medicación en 3 o más tomas al día (OR 3; IC95% 1,1–8,4; p=0,03) y los pacientes poco informados sobre su EII (OR 4,9; IC95% 1,1–23,8; p=0,04); por el contrario, la terapia con inmunomoduladores fue un factor predictivo de mejor adhesión (OR 0,29; IC95% 0,11–0,74; p=0,01). La concordancia medico–paciente en la medicación administrada fue completa en 86%, en 10,3% hubo diferencias en la dosis y en 3,7% diferencias en la medicación. Un 9% de enfermos reconoció haberse automedicado en alguna ocasión debido a presentar brote. Conclusiones En nuestro medio, la adhesión al tratamiento en enfermos con EII es insuficiente. Los pacientes en tratamiento con inmunosupresores presentan una mejor adhesión al tratamiento. Debemos intentar optimizar la información que proporcionamos al paciente sobre su EII y administrar la medicación en una o dos tomas al día para conseguir mejorar el cumplimiento terapéutico.
    Article · Mar 2009 · Gastroenterology
  • Article · Mar 2009 · Gastroenterology